Dengue Catch-22
by Brigsee
Summary: The tropical Philippines, a pleasant life for an Aussie Expat; what of the dangers? My Dengue experience certainly scary and possibly fatal if infected again. Three strikes and possibly out.
1. Dengue Symptoms Stage 1

Sunday April 3rd 2016: I'm exercising; it's good for one's mental and physical wellbeing. And now getting older I'm losing muscle tone; loose skinny arms. The last routine sit-ups, I experience pain in both knees and only complete one set of eight. It's the hot dry season in Cebu, and when finished exercising, sweat floods my eyes. After a cold shower, I rest in my air con room, and suffer an irritating back itch all day. Everybody complains about the heat, blaming El Nino, this year most certainly hotter than last.

Next morning, I notice a pinkish rash on both inner arms and ask my neighbour to inspect my back and take a few pics. She confirms a red rash on my back and asks do I suffer allergies? No!

After stripping down the bed and fumigating the room, perhaps insects or bugs cause the rash, I take rest with the air con on. My temperature escalates but never into a real bad fever. I drink only water for the next few days and take Ciprofloxacin. No food at all, I'm not hungry.

Come Wednesday I'm suffering joint and muscle pain, my temperature still up, but the bed never wet from excessive sweat. The rash and itch not improving, I research the internet and discover a site with photos of many skin rashes. I find mine, Dengue Fever.

My friend Ben, another Aussie expat was hospitalised last September with Dengue and described his symptoms.

Excruciating headaches, especially behind the eyes, forced him to seek medical treatment. (Not me.)

High fever, constant sweating. (Partially me.)

Severe joint and muscular pain. (Yes me, painful but not severe.)

Bleeding gums. (Not me.) Thank goodness because this I discover on the internet is very serious.

Very low platelet blood count. (I should get a test.)

Ben never mentioned a rash.

I email Ben.

On 7 Apr 2016, at 11:13 AM:

Hello Mate

I've been scarce lately. Pretty sure now it is dengue but mild compared to you.

Did you get a red rash on your back and ARMS? A bit itchy.

The muscular pain is the worst thing for me ... no heaDACHES.

aND BRAIN MORE LETHARGIC

Tks

Date: Thu, 7 Apr 2016 16:07:33 +0800

Hi mate,

No I did not get the rash. But there are apparently 5 different strains of dengue. So rash in itself is not a defining symptom on its own but it is a symptom combined with sore muscles, fever, headaches. But if in doubt get a simple blood check best to catch it early before you end up in hospital. That's was my stupidity putting up with the symptoms for too long. Male pride I guess.

Regards

On 7 Apr 2016, at 4:20 PM:

Hello Ben

I've got the sore muscles and joints last night, no headaches or any other pain. Tues had elevated temp but no big sweats.

See how I feel tomorrow.

Have a beer for me ...

Thanks

Ben soon replied, I suspect from the bar.

I'll have more than two for you mate. Cheers!

Remember if it continues best get blood test and sorted early, as left to late, hospital cost me over 20000 peso.

Regards


	2. Feeling Better Stage 2 (Danger)

Wednesday, Thursday and Friday, feeling a little improved, I venture to a nearby pharmacy; painkillers brought from Australia are almost finished. I need painkillers to reduce muscles and joint discomfort before I can sleep. The internet advises NOT to take aspirin or Ibuprofen as they may incur haemorrhaging. At this stage of the virus plasma leakage takes place and bleeding could lead to shock and possible death. I explain to two female pharmacy staff what I don't want, after deliberation in Visayan (local dialect) they suggest Mefenamic acid. I purchase four capsules. On my way home I drop into a bar and let the proprietor know why I'm absent of late. He offers strong flu medicine capsules. Thanks mate! Because researching the internet I discover Mefenamic acid may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Communication problems often occur in the Philippines because English is their second language, and American accents, much easier understood by Filipinos.

I don't venture into the heat looking for doctors and blood test clinics. Cebu's forecast for mid-thirties Centigrade but it's far more oppressive. In early December I had blood tests at the Chong Hua, Cebu's leading hospital according to other foreigners. Very crowded, long waits in both the hospital and nearby Doctors rooms; mayhem! Stuck in a room full of sick people, a recipe for disaster. And Chong Hua is some distance away; there must be a clinic closer to home.

Come Saturday morning with improved stamina I ask a housemate to call a nearby clinic, discovered on the internet. I ask her to enquire if I can get a blood test there. Speaking English on the phone is often a waste of time for foreigners. No answer from the clinic. I taxi over, two helpful staff but no doctors available today. They suggest a clinic in the nearby mall, one which I hadn't seen on the internet. I didn't ask about the unanswered phone.

A CBC (Complete Blood Count) and Dengue Rapid Test are performed in the clinic, no Doctor's referral required. After only a twenty minute wait I'm greeted by a "Lady Boy" who will take my blood. I ask 'Have you done this before?'

My attempted humour not recognised, maybe not appreciated, I try again.

'Is it ok, I look away?'

The Lady Boy laughs this time saying, 'Look away Sir! Before, I hate the sight of blood.'

Nothing felt, two vials fill in less than a minute. I often experience several unsuccessful stings and jabs until striking a loaded vein. This time not even a little prick! However next day I discover a dark bruise one inch (2.5 cm) in diameter, something I never experienced before from a blood test. Easily bruised; another Dengue symptom.

It's a one hour wait for the results; off to the supermarket. Upon receiving a positive dengue result, staff suggests I see their doctor. The tests cost 1200 Peso and the Doctor 330 Peso.

My body temperature 35.6, blood pressure 100/80 and weight 68.5 kilos; I only lost one kilo. The platelet count is in the lower normal range. My WBC (White Blood Cell) 4,000/ mm3 somewhat below a normal range of 5,000 to 10,000. The doctor insists on me going directly to hospital as I might haemorrhage and go into fatal shock any time.


	3. Stabilise Stage 3

I walk home in the heat, less than a kilometre carrying groceries bought whilst waiting for the blood test results. My appetite returns, having fasted the last five days. I feel okay!

I'm the only foreigner living in a large house, six bedrooms rented out. My air con room costs 6000 peso a month plus utilities. At home, housemate's plea with me "Go to hospital!"

They want to call an ambulance. I say 'No!'

A big Lesbian girl, her heart of gold, nearly crying. 'Taxi! I go with you in taxi.'

I put them off saying 'Wait for the Landlord and I will follow his advice. '

Dengue often occurs in the Philippines and many lose a relative or friend to the world's most dangerous creature; the mosquito.

Housemates got to the landlord first, and I'd just returned from buying water from the station 100 metres away. I carry back 6 litres not the usual 20 litres but enough to raise a sweat in the heat. The landlord claims I look terrible and we must go to hospital; go now. A small bag packed, we catch a taxi to a nearby hospital, first stopping at an ATM for 30,000 peso. Best prepare for the worst.

The Perpetual Succour Hospital, an unexpected surprise! I'm on a trolley bed and wheeled into a cubicle within ten minutes. Two female interns ask questions; take my BP 120/80 and Temp 36.5. I complete an admission form. When the resident doctor arrives she soon concludes that I'm over the worst of it. My CBC stable, come back tomorrow (Sunday) for a precautionary CBC.

I ask for a prescription, pain killers with codeine.

'Codeine isn't freely available in the Philippines.' She replies. 'You might get high and chase me around the ward.'

Indeed I might when healthy again; she is early thirties, nicely chubby, attractive face and delightful personality. Doctor prescribes Tylenol Paracetamol 650 mg and Levocetirizine an antihistamine for my back, the rash gone but not the itch. I hadn't mentioned the itch, low on my priority list but I'm certainly pleased she remembers.

Doctor casually mentions as I gather my bag and shoes that the Dengue Rapid Test suggests an occurrence of Dengue fever before. I research this news first thing, when back home. The hospital consultation cost 505 Pesos, if admitted it cost 1100 Peso per night for a twin shared room plus the extras.

I discover online a 62% probability that I previously suffered Dengue Fever on at least one or possibly more occasions.

Back to The Perpetual Succour Hospital on Monday for another CBC, a small bag packed in case of the worst. I'm not suffering any symptoms but somewhat weak. The test cost 164 Pesos and only a ten minute wait to give blood and a forty minute wait for the result which I take to admissions asking if a doctor is available. A female resident doctor soon arrives. She smiles comparing the two results and concludes that I'm stable. 'Go home, relax. Return if you suffer abdominal pain or bleeding.'

I sense she's aware of my previous visit.


	4. Dengue or Lifestyle Stage 4 (Catch-22)

When did I first suffer Dengue?

Before returning to the Philippines in August 2014, I stayed in Fujian Province China for seven months. I never considered Fujian a Dengue location but discover on the internet several recent outbreaks both there and also Guangdong Province directly south and adjacent to Hong Kong. And nearby Taiwan across the strait from Fujian, is considered a Dengue hotspot. I'd been to Hong Kong twice for visa extensions, both times stopping overnight in Shenzhen, Guangdong Province. I recall being ill after the second HK visit, headaches, sight problems and lethargy but no fevers, rash, muscular or joint symptoms. I was renting a comfortable modern apartment, but with poor bathroom ventilation, cleaning black mould became a continuous chore. After moving to another apartment, I recovered almost overnight.

My first Dengue experience probably occurred in Cebu, I guess November last year. I remember complaining to Ben that I'm not processing alcohol so well these days. Suffering hangovers and memory loss following a tame night at the bar; Dengue affects the liver. In addition I experienced bleeding into the skin, on the arms with no apparent cause at that time. My Mum's arms are covered in these bruises; I put it down to hereditary. And I experienced motivational loss and lethargy for several months; finally I got some energy back then Dengue (again). It's taking seven weeks to complete these few pages.

Another foreign friend, Swiss Tony, hospitalized for a month with Dengue several years back, recovered quickly. Ben suffered severely. Feeling healthy after a few days and contrary to Doctors opinion, signed himself out of hospital and came directly to the bar; never looking back. Age may be a factor, Ben is twelve years younger. I abstained 15 days from beer before meeting up with Ben and comparing Dengue notes. Ben recommends I take vitamins to help get back my motivation.

'Thiamine, Vitamin B group is great for the brain.' Ben explains. 'I took massive doses daily when in rehab.'

'How long were you in rehab?' I ask.

'Only three months!' Laughs Ben.

'Three months without a beer?'

'Three months in rehab and another long, long dry nine months. You know people are idiots when they drink? They repeat themselves, laugh at nothing, argue about the least important things, it was torture meeting mates at the bar. Mate! So tempting to be an idiot again.'

'A year?'

'A year to the day!'

'What were you trying to prove?'

'I promised to do it and I did. Surprised everyone including myself.'

'Who did you promise?' I'm curious whenever Ben reveals snippets from his past.

'My employers! They were good enough to pay the rehab, eleven hundred a day. I thought it only fair to contribute a further nine months or be sacked.'

Another foreigner joins us at the bar, referring to me and Ben as the "Dengue Twins", Ben's rehab history must wait another time.

Next morning Ben sends a text; "Supraneuron". Online describes a high dosage vitamin B group tablet prescribed for amongst other disorders, "alcoholism & during withdrawal therapy of alcoholism". Inexpensive at 17 peso a tablet I also buy Pluravit multi vitamin and mineral supplement; 130 pesos for 30 tablets at a supermarket. I'd never taken vitamin tablets before, relying upon a daily diet of vegetables minimal meat for flavour, and fish whenever available to keep healthy. Bananas are the only fruit I eat daily. Occasionally I get a taste for Mangos, Papaya (Paw-Paw) and a few local fruits when in season. Oh! Chilli, garlic, ginger and onions form part of my daily diet, both cooking and sometimes in turmeric tea. Vitamins won't hurt; I need to kick-start my life again. After a few weeks I experience some improvement. Ben's recommends replacing Supraneuron with Berocca taken every second day; 190 pesos for ten tablets. Ben's logic, Berocca supplies both Vitamin B group and mineral supplement; don't renew the Pluravit. I recall Berocca as fashionable back in the eighties, a hangover preventative if taken before sleep or first thing in the morning as a cure. One Christmas I received three Berocca packages from well-meaning friends, but I never became an enthusiast.

Since living in the steamy Philippines I've been drinking two large bottles (1.5 litres) of Gatorade per week as an electrolytes source. I go little on the taste and the high sugar content. So I turn to the internet for an alternative source. I now mix two teaspoons of bi carbonate of soda, less than half a teaspoon of salt, a teaspoon of sugar, lemon juice to 2.5 litres of water. Never consumed with or close to meals, I drink half a litre of home electrolyte per day and approximately three litres of water. Whether it's the increased electrolytes intake, the vitamins, or just normal recovery from Dengue; good news! I'm more motivated most days. But not every day!

There are four Dengue strains probably with variable symptoms? We don't know which strains affected us. And the individual response to disease can differ, possibly a reason for a variance in symptoms and recovery.

One of several real positives of life in the Philippines, my arthritic knees rarely bother me. An Aussie winter often includes quite cold periods and in China I suffer more because of the winter chill. And now another Dengue legacy, persistent arthritic knees, I buy a knee support.

So what now? The Dengue carrying mosquito is a day feeder, most active at dawn and dusk. I don't venture outside so much in daylight and when I do, a shirt on and mosquito repellent both mandatory. I'm resistant to one or two Dengue strains, so if unlucky enough to be bitten again I have a fifty-fifty chance of not being affected. Where I live; no other Dengue victims, house mates don't use repellent and the males often forgo a shirt to keep cool. And the back yard where I previously sat is enclosed with insect mesh. Ben and I only meet at the local bar, and no other regulars there suffered Dengue. What are my chances of being infected by the remaining two strains; marginal?

However if that unlucky, another Dengue bout could be severe because my immune system no longer recognises Dengue as a foreign invader, next time putting out the "Welcome Mat".

In Australia, China and Philippines I'd been casual regarding Mosquitos because they never bite me when in company. A meal of last resort, I rarely suffered mosquito bites, unlike my friends and companions when enjoying outdoor activities. I don't recall being menaced here, but had a habit of sitting outside around dusk, with a burning mosquito coil. I sprayed inside my room every second day before going out; fearing insecticide more than mosquitoes. And I purchased an electric mozzie liquid repellent for sleep. I'd taken precautions since Ben's experience; but not enough.

Cebu city's key negatives, pollution and traffic snarls and of course mosquitoes. Cebu's charm? You can catch a bus or ferry to many relaxing beaches and other activities nearby. Travel here is safe but traffic obstacles can be frustrating. Promo flights are often available to exotic locations both local and abroad. My last trip out of Cebu was last August; more or less a year already. And I'm not keen as yet to venture far from Cebu's Perpetual Succour Hospital because if I suffer Dengue symptoms, I'm straight there. An itchy back has me asking housemates to check for a rash; a lasting psychological victory for the mosquito.

Why not move to a Dengue free location? I enjoy life here in the Philippines. The climate suits, cost of living is relatively inexpensive, beer tastes good and cheap, and the people are fine. Cuisine is not a problem. I'm happy with the local food, most menus exist here. Cebu is a safe city but like any city one should show caution especially at night. Inexpensive taxis are on hand except in rush hour, so there's no need to walk at night. Believe it or not, Cebu taxi drivers are 95% courteous and honest. My main drawback here is lack of motivation. I'm working on it, exercise, electrolytes, vitamins, healthy diet and achieving a moderate beer intake. What is moderate? Less than ten bottles (330 ml) daily of San Miguel Light or Pilsen leaves me fine in the morning. Both 5% alcohol content and both thirst quenching on a tropical day. Every day is tropical in the Philippines, abstaining one or two days a week proves difficult. Dengue or lifestyle; a catch-22.


End file.
